This blog is totally independent, unpaid and has only three major objectives.
The first is to inform readers of news and happenings in the e-Health domain, both here in Australia and world-wide.
The second is to provide commentary on e-Health in Australia and to foster improvement where I can.
The third is to encourage discussion of the matters raised in the blog so hopefully readers can get a balanced view of what is really happening and what successes are being achieved.

Saturday, April 09, 2016

Weekly Overseas Health IT Links - 9th April, 2016.

Note: Each link is followed by a title and few paragraphs. For the full article click on the link above title of the article. Note also that full access to some links may require site registration or subscription payment.

The April 2016 target for getting third-party suppliers of patient facing services integrated with the principal GP systems will not be met.

The first of these integrations will now likely go-live in late spring.

When a new GP Systems of Choice contract was signed in March 2014, it specified that principal system suppliers [Emis, TPP, INPS and Microtest] must provide interface mechanisms to allow the suppliers of subsidiary services to integrate with them.

Clinical decision support misfires are commonplace but often hard to detect, according to a close examination of CDS systems at Brigham and Women's hospital in Boston published in the most recent Journal of the American Medical Informatics Association.

In addition, a separate poll of chief medical information officers found that the vast majority – 93 percent – had experienced at least one CDS malfunction, according to researchers. Two-thirds experienced system failures on an annual basis.

Sometimes, before I interview new patients, while I’m waiting for them to be transported from the emergency department to the medical floor, I play a game.

I look through their lab tests. I peruse their imaging studies. I read other doctors’ notes and recent discharge summaries. Then I guess what the diagnosis is.

I know this is bad. It goes against most of what I learned about good doctoring in medical school — that the patient’s story is the core of medicine, that it’s essential for accurate diagnoses and therapeutic relationships.

It can also be dangerous. When I interview patients, I often find their medical charts are littered with inaccuracies. It’s one reason “read it in my chart” isn’t a good way for patients to communicate health information — or for doctors to learn it.

Contact-free sensors, CDS platforms and even a video game are part of the digital health arsenal deployed to battle this deadly condition.

The recent death of film and TV actress Patty Duke is shining the spotlight on sepsis, a life-threatening condition that can be detected with mHealth technology.

The Centers for Disease Control and Prevention defines sepsis as “the body’s overwhelming and life-threatening response to infection which can lead to tissue damage, organ failure, and death,” and says it’s hard to predict, diagnose and cure. It affects about 1 million Americans and kills about 200,000 each year, more than AIDS, breast cancer and prostate cancer combined, and costs the nation’s healthcare system roughly $54 billion to treat.

Sepsis requires a quick diagnosis. Every hour of delayed care worsens outcomes by 6 percent, and about 30 percent of those who lapse into septic shock end up dying. mHealth platforms offer the ability to alert healthcare providers as soon as any symptoms are detected.

Police departments, government offices, corporations, and countless individuals have been victims of malicious software that encrypts data and demands payment for its return. But a spate of recent ransomware infections at hospitals has some experts worried that patient care could suffer.

“The big difference with health care is that the consequences are greater,” says Kevin Fu, an associate professor at the University of Michigan who studies computer security issues in hospitals. “You can lose your e-mail and that’s annoying, but patient records are needed in order to treat patients.”

After ransomware struck Hollywood Presbyterian Hospital in Los Angeles in February, the hospital's central medical records system was largely unusable for 10 days, and some patients had to be transported to other hospitals. A hospital in Germany that had medical records locked up by ransomware canceled some high-risk surgeries for safety reasons.

Explosion of data volumes. Interoperability of systems. Large servers in the sky that can analyze enormous amounts of data, compute complex algorithms in real time, and communicate in microseconds. Mobile communication through devices that patients, providers and staff all carry all the time. What does this all mean for hospital operations? Based on working with dozens of hospitals and conversations with 100+ others, we think the near future of hospital operations is quite exciting. Call it what you will — “Hospital 2.0,” “No Waiting Rooms,” “Hospital Operations Center” — the basic building blocks to enable the future of hospital operations are already here.

Today, two major shifts are putting pressure on hospitals to rethink how they deliver care: (a) increased demand for care from the Affordable Care Act and the growing number of people with chronic illnesses and (b) the move toward value-based care.

Healthcare information and security officers are leading efforts to avoid cyberattacks through training and tools as 81% of healthcare executives say that their organizations’ systems have been compromised during the past two years.

Now that cyber attacks as a source of data breaches are becoming routine in and out of healthcare, each breach represents not just a monetary loss to providers and payers but also a loss of faith by customers and patients in the healthcare industry. This new fact has pushed data security way up the priority list for healthcare.

Consider this: 81% of healthcare executives say that their organizations have been compromised by at least one malware, botnet, or other cyber attack during the past two years, and only half say they feel that they are adequately prepared in preventing attacks, according to a 2015 KPMG healthcare cybersecurity survey.

It has not been a good few months for disruptive “unicorn” companies in the healthcare sector.

First came questions over the accuracy of blood testing technology developed by Theranos, the much-hyped Silicon Valley start-up whose 32 year-old founder, Elizabeth Holmes, had promised to revolutionise medical diagnostics.

Next to have its bubble burst was Zenefits, the HR software company which set out to challenge traditional health insurance brokers. Its similarly youthful founder and chief executive, Parker Conrad, was ousted in February amid concerns over the Californian company’s compliance with insurance laws.

The humbling of Theranos, Zenefits and their high-profile young founders marks the first big setback for the wave of technology companies aiming to make healthcare the next industry to feel the force of digital disruption.

The rate of security incident disclosures in 2015 surpassed those of 2014 and 2015, according to the inaugural 2015 BakerHostetler Security Incident Response report. What’s more, healthcare tops the list for frequency of data breaches.

“It’s not if, but when an incident will occur,” BakerHostetler said. “Privacy and data security issues are firmly entrenched as a significant public and regulatory concern and a risk-opportunity that executive leadership and boards of directors must confront.”

As part of the report the law firm published a 7-point plan to help healthcare organizations avoid breaches and ultimately respond when they do occur.

Shared access to records through a patient portal offers a way to overcome barriers such as patients' limited technical skills and health literacy, though it's rarely used, according to a study published in the Journal of the American Medical Informatics Association.

Researchers surveyed 323 patients and 389 care partners who had shared access to the Geisinger Health System patient portal, MyGeisinger. More than a decade after patients were offered use of the portal, they found that just 0.4 percent of registered adult patient portal users shared access to their account with a family member or friend.

Other studies have found that nearly all patients want control over their electronic health information, but they vary considerably in preferences for sharing their information with others.

Two citizens’ juries have backed an opt-out model for a database of health records that could be used for research and other purposes other than direct patient care.

The University of Manchester set up two citizens’ juries, with 34 members of the public involved in total, and arranged for them to spend three days taking expert witness testimony on the creation of health records and access to them.

At the end of the process, 33 of the 34 jurors backed the creation of a health database and 24 supported an opt-out model for the inclusion of records. Six favoured an opt-in model.

Healthcare professionals are demonstrating a better understanding of HIPAA compliance measures, just in time for the phase 2 OCR HIPAA audits.

The survey looked at HIPAA compliance trends amongst 927 healthcare professionals as a follow-up to a similar 2014 survey.

In the course of the past two years, more healthcare professionals have brushed up on their HIPAA knowledge. Today, a total of 69 percent of respondents knew about and understood the HIPAA Omnibus Rule, while only 64 percent of 2014 respondents reported the same.

The World Health Organization (WHO) has released a new app this month, called WHO Zika App, which offers medical reference information about the Zika virus. The app is specifically designed for health care workers and responders, but can also be used by the general public.

Zika is a disease that is transmitted by Aedes mosquitoes. Symptoms of this virus include mild fever, skin rashes, conjunctivitis, muscle and joint pain, and a headache, according to WHO, but the disease also comes with a complication. Researchers have found an increasing body of evidence linking Zika virus and microcephaly, a condition in which a baby is born with a significantly smaller head than expected.

Between project development and technical steps, EHR replacement projects should take a slow and steady approach.

As the healthcare industry shifts to new models of care, healthcare organizations look to enhance their EHR technology through EHR replacements and EHR optimizations.

Between care coordination, patient-centered care, and the persistent push for interoperability, EHR replacement projects are coming to the forefront for healthcare executives. This can be a daunting task, experts say, but there are some steps healthcare organizations can take to ease the process.

After extensive pilot testing, AllClear ID, a vendor of breach preparation and response services, has rolled out a comprehensive program that guarantees that healthcare organizations have access to company resources when they’re needed.

AllClear ID’s new program, called Reserved Response, is aimed at mid-sized and larger hospital systems and insurance carriers; the company commits the talent and services will be standing by and ready to deploy within 48 to 72 hours.

Lucia Savage, chief privacy officer in the Office of the National Coordinator for Health IT, is fighting to dispel a widespread and persistent misconception in the healthcare industry: that HIPAA makes it difficult, if not impossible, to move electronic health data for patient care.

A lawyer by training, Savage joined ONC in October 2014 determined to set the record straight on the federal law. According to Savage, some healthcare providers are not sharing protected health information because of their organization’s policies, procedures or protocols—even if such data exchange is permitted under HIPAA. In fact, providers often will not share PHI with each other or payers without written patient consent.

Clinical decision support is designed to deliver the most relevant patient data to the physician at the time it is most needed – namely, when a critical choice about care has to be made. It is not a new concept and the healthcare industry certainly has the technology available to make it work at an optimal level.

Still, there is room for improvement on both the provider and vendor ends, say specialists in the CDS field.

"The traditional definition of CDS is what you can do within the electronic health record to support better decisions, but across the industry the state of decision-making is really bad," said Dale Sanders, senior vice president of Salt Lake City, Utah-based Health Catalyst.

Each has pros and cons, including accuracy, price and the potential to scare patients with Big Brother-like perceptions. And biometric technology is evolving quickly enough that hospitals need to frequently evaluate options.

When University Health Care System was deciding which biometric technology to deploy in conjunction with its Epic EHR, the Augusta, Georgia, hospital opted for iris recognition.

“It’s more accurate than fingerprint scanning and vein mapping, and a plus is that it’s a clean process because the patient never has to touch anything, which is a big issue in healthcare because of infection control,” said University Health Care revenue cycle director George Ann Phillips (pictured). “The camera sits on a tripod and it is voice-activated and tells a patient exactly how to position their head right before it snaps a photo.”

Iris recognition is just one in an emerging field of biometric technologies — others include palm-vein, fingerprinting and facial recognition — for identifying and authenticating patients.

In that proposed rule, HHS notes that qualified practice settings includes ones that are "registered for their state prescription drug monitoring program (PDMP) where operational and in accordance with federal and state law."

Doctors' frustration with electronic health records and clinical quality reporting can play a role in physician burnout, Steve Stack, M.D., president of the American Medical Association, tellsEHRIntelligence.com.

"Doctors will get behind things that support better quality of care and support them in their clinical practice. It's the nonsensical stuff that makes it infuriating and challenging," he says.

Providers can feel overworked and unsupported when federal mandates add to the stress of their already busy lives, leaving them working nights and weekends. Stack adds that many aspects of EHRs are frustrating--they are inefficient, they're often not interoperable with other systems and they go down and paralyze the healthcare systems that depend on them.

Clinicians at MedStar Health can now review medical records and submit orders via the electronic health record after a malware attack March 28 forced computers offline, the Maryland-based hospital chain said in a statement Wednesday morning.

MedStar, which operates 10 hospitals throughout the District of Columbia and Maryland, said its "three main clinical information systems supporting patient care" are still moving toward full restoration thanks to round-the-clock efforts by its IT team, as well as cybersecurity experts. Patient and associate data, thus far, has not been compromised, analysis has shown.

"Restoration of additional clinical systems continues with priority given to those related directly to patient care," the statement noted.

One year ago, when the largest data breach on record took place, at Anthem, the call went out from numerous IT security experts for the healthcare industry to take its data protection measures to a whole new level. For once, it seems, the industry listened.

In the wake of the Anthem data theft, “Adopting security technology has received a lot more attention throughout the healthcare sector. That, plus falling price points, has led to it being more widely adopted than it was a year ago,” says Kathy Hughes, chief information security officer for Northwell Health (formerly Northshore-LIJ Health System), New York State’s largest healthcare provider.

So does that mean patient data is safer today than at the time of the Anthem break-in? “Yes,” replies Hughes, “absolutely.”

As the Department of Veterans Affairs ponders whether to continue upgrading its legacy electronic health record system or to replace it outright, the VA has awarded 21 contracts worth up to $22.3 billion for information technology infrastructure improvements.

While the agency conducts a business case analysis on the future viability of its Veterans Health Information Systems and Technology Architecture (VistA) EHR system, a new multi-billion dollar indefinite-delivery, indefinite-quantity contract vehicle has been put in place to help meet the VA’s near- and longer term healthcare IT needs.

The 10-year Transformation Twenty-One Total Technology program-Next Generation (T4NG) awards include a mix of large and small business vendors, serving as a follow-on procurement to the original T4 program.

In the world of medicine, trial and error is largely the norm today. Doctors make a "most likely" diagnosis consistent with symptoms and prescribe treatment accordingly—treatment that might include drugs, devices or surgery. If the treatment doesn't work, the doctor most likely alters dosage or prescribes something else. This iterative cycle is repeated until the diagnosis and treatment present the desired clinical outcome.

The bad news is that this paradigm has reached a point of diminishing returns, as evidenced by the fact that most drugs prescribed in the United States today are effective with fewer than 60 percent of treated patients. The good news is that new technology could transform trial-and-error medicine, replacing it with an evidence-driven paradigm—one in which each patient receives care, medication and treatment predicated on his or her unique genomic profile and its attributes.

As consumers continue to embrace mHealth tools to track their care, researchers are using the devices in a different way--as part of clinical trials.

One institute using the tools this way is Chicago's Northwestern University. Researchers at the Feinberg School of Medicine, for a clinical trial, have created a website and mobile apps that allow physicians to teach mental health patients therapy techniques and show situational use of techniques via text, video and animation technologies, according to a Healthcare IT Newsreport.

Not only do the website and apps make it easier to engage trial participants, they can also lower costs.

A computer virus forced MedStar Health, which boasts 10 hospitals throughout the District of Columbia and Maryland, offline late Monday, the Associated Press and the Washington Postreport. The health system is working with the FBI, according to the AP, which is investigating the possibility of a ransomware attack.

According to a statement posted to MedStar Health's Facebook page, the virus prevents certain users from logging into its systems. MedStar took down all system interfaces to prevent the virus from spreading.

"Currently, all of our clinical facilities remain open and functioning," the statement says. "We have no evidence that information has been compromised."

Protecting Employees’ Health Data

You and your doctor know the answers to these questions, and now others may too: businesses that are contracting with employers to collect and analyze employee health data. But federal privacy law does not provide safeguards for how this information is used.

A Wall Street Journal report last month looked at a company called Castlight Health, which analyzes employees’ health care claims and demographic data to make predictions about their health care needs — for instance, women who have stopped filling their birth control prescriptions might become pregnant. It then gives employees advice intended to help them get the most out of their health care benefits (if a woman stops purchasing birth control, it might send her an alert about the benefits of a preconception visit to an obstetrician). It also gives employers aggregate data on their workers, like the number of employees it predicts will become pregnant soon.

The virtual healthcare market is expected to reach revenues over $3.5 billion by 2022 with a CAGR of 49.8 percent during the forecast period, according to a recent report by Verify Markets. The report represent revenues generated by companies operating in the U.S. virtual healthcare market by mode of consultation (online visits to physicians through various modes of communication such as audio, video and kiosks).

Core Virtual Healthcare Market Segments

Growth in the virtual healthcare market is largely being driven by revenue generated from three core segments:

1. Video Consultation– revenues generated from video consultation services used by patients through their personal devices such as laptops, tablets, smartphones and desktops

2. Audio Consultation – revenues genereated from audio consultation used by patients through their telephonic devices

WASHINGTON (AP) — Hackers crippled computer systems Monday at a major hospital chain, MedStar Health Inc., forcing records systems offline for thousands of patients and doctors. The FBI said it was investigating whether the unknown hackers demanded a ransom to restore systems.

A computer virus paralyzed some operations at Washington-area hospitals and doctors' offices, leaving patients unable to book appointments and staff locked out of their email accounts. Some employees were required to turn off all computers since Monday morning.

A law enforcement official said the FBI was assessing whether the virus was so-called ransomware, in which hackers extort money in exchange for returning a victim's systems to normal. The official spoke on condition of anonymity because the person was not authorized to discuss publicly details about the ongoing criminal investigation.

With reports from MedStar Health indicating that the system’s computer systems remain down a second day after a cyber attack Monday, providers have a new sense of urgency in ensuring they have firm plans for responding to a breach.

A new 29-page Data Breach Response Guide from Experian helps IT and other healthcare executives put together an enterprisewide plan to prepare for and respond to a breach, and then put the plan into motion when an incident occurs.

Sections in the guide cover communicating with the C-suite; creating a plan; practicing the plan; responding to a breach; auditing the plan; and finding helpful resources. The guide also includes a readiness assessment, containing core questions, to assess whether an organization has plans in place to appropriately respond to a breach.

Optimizing block scheduling for hospital operating rooms is a potential cost savings for health systems. Having the right tools and the right data is imperative.

While it’s possible to bemoan the industrialization of healthcare, when large amounts of resources— represented by operating rooms, hospital beds, and staff—it is essential that healthcare systems look for inefficiencies and squeeze them out.

Faced with increasing demands for its services and the realities of providing integrated healthcare in the 21st Century, the Department of Veterans Affairs is having second thoughts about sticking with its legacy electronic health record system.

Although the VA has been modernizing the Veterans Health Information Systems and Technology Architecture (VistA) over the last couple of years, the department is “taking a step back” from this system modernization to reassess its future clinical needs and to determine whether it should move forward with VistA or follow the lead of the Department of Defense—which last year awarded a $4.3 billion contract to a Leidos-Cerner team—and procure a similar commercial off-the-shelf EHR system.

Electronic health records and health IT are falling short when it comes to improving patient medication adherence, according to a new paper in JMIR Medical Informatics.

The authors, from Duke University Medical Center and elsewhere, warn that non-adherence is "common and costly" and "one of our largest public health issues." Health IT can help improve adherence, with tools such as electronic prescribing, clinical decision support, linkages between diagnosis and treatment plans, and the use of patient portals to improve communication.

However, health IT has four "gaps" or barriers that are impeding efforts to improve medication adherence:

Interoperability, connectedness and reciprocity, which is "undeveloped." Patients can't connect self-monitoring data to a doctor's EHR; the systems don't capture medication refill rates or patient reports of side effects. Moreover, with 160 different medication adherence apps available, creating a system to connect all of them to EHRs is "daunting," the authors write.

Fifty-nine percent of consumers who use digital health apps and tools suffer from a chronic condition, according to a March HealthMine survey of 500 insured consumers. Fifty-two percent of these individuals are enrolled in a wellness program and 33% received their health device/app from their wellness program.

However, only 7% of these individuals are using a disease management tool. The survey reveals that consumers use of health applications and devices has doubled in the past two years, but the right digital health tools are not necessarily getting into the hands of those who need them most.